Ranking the Seahawk’s Seattle vs. the Patriot’s Boston in the Health Care Bowl

By Clive Riddle, January 30, 2015

Given that the contest between the Seattle Seahawks  vs. the New England Patriots in Super Bowl XLIX is a product of listing and ranking NFL teams (by wins and losses), perhaps some irrelevant insights into the outcome of that contest can be gleaned by comparing how the two cities rank in various healthcare lists.

Of course the immediate challenge is to assign a city to the Patriots. Foxboro- the site of their stadium? The entire New England region and all metro areas within? We’ll deflate their claim to a multi-state region, and go with just Boston.

Looking to healthsprocket, the site for healthcare lists, we find these eight lists posted during the past year, which include mention of Seattle or Boston.  The result is basically a tie, based on mentions – unless you deflate the Patriot’s claim to Springfield and Worcester, in which case Seattle might prevail in a sqeaker.

There is a list claiming overall healthcare rankings – that puts Boston at #2 with Seattle whiffing:

Ranking Of The Best Healthcare Cities In The U.S. (Source: iVantage Health Analytics)

  1. Washington, DC
  2. Boston
  3. Minneapolis
  4. Portland, OR
  5. Chicago
  6. Charlotte
  7. Philadelphia
  8. Atlanta
  9. New York
  10. St. Louis

On the other hand, Boston makes the Most Expense Healthcare Cities list (#9), unlike Seattle:

10 Most Expensive Cities for Healthcare (Source: Castlight Health)

  1. Sacramento, CA
  2. San Francisco, CA
  3. Dallas, TX
  4. St. Louis, MO
  5. Kansas City, MO
  6. Charlotte, NC
  7. Denver, CO
  8. Miami, FL
  9. Boston, MA
  10. Portland, OR

Seattle makes this list of lowest cost bronze plans (at #18) in 2014 public exchanges, unlike Boston

2014 Lowest Cost Bronze Plan After Subsidies by Largest City in Each State For A Single 25 Year Old (Source: Kaiser Family Foundation)

  1. Los Angeles, CA - $140
  2. Denver, CO - $142
  3. Hartford, CT - $117
  4. Washington, DC - $124
  5. Indianapolis, IN - $157
  6. Baltimore, MD - $115
  7. Portland, ME - $146
  8. Billings, MT - $152
  9. Omaha, NE - $135
  10. Albuquerque, NM - $122
  11. New York City, NY - $111
  12. Cleveland, OH - $136
  13. Portland, OR - $130
  14. Providence, RI - $127
  15. Sioux Falls, SD - $173
  16. 16.Richmond, VA - $127
  17. 17.Burlington, VT - $116
  18. 18.Seattle, WA - $138

Seattle is also the place to be if you don’t like waiting for your doctor – ranked at #1, with Boston not mentioned

Top 10 Cities With The Shortest Average Wait Times To See The Doctor (Source: Vitals)

  1. Seattle, WA- 16 minutes, 15 seconds
  2. Milwaukee, WI- 16 minutes, 17 seconds
  3. Denver, CO- 16 minutes, 25 seconds
  4. Minneapolis, MN- 16 minutes, 42 seconds
  5. Portland, OR- 17 minutes, 05 seconds
  6. Omaha, NE- 17 minutes, 23 seconds
  7. Charlotte, NC- 17 minutes, 26 seconds
  8. Austin, TX- 17 minutes, 32 seconds
  9. San Diego, CA- 17 minutes, 43 seconds
  10. Raleigh, NC- 17 minutes, 48 seconds

Boston Children’s comes in #1 in this list of best Children’s hospitals, while Seattle is ignored:

Deborah Kotz: The Honor Roll of Best Children's Hospitals 2014-15 (Source: The Boston Globe)

  1. Boston Children’s Hospital/ Children’s Hospital of Philadelphia (tied)
  2. Cincinnati Children’s Hospital Medical Center
  3. Texas Children’s Hospital, Houston
  4. Children’s Hospital Los Angeles
  5. Children’s Hospital Colorado, Aurora
  6. Nationwide Children’s Hospital, Columbus, Ohio
  7. Ann and Robert H. Lurie Children’s Hospital of Chicago
  8. Children’s Hospital of Pittsburgh of UPMC
  9. Johns Hopkins Children’s Center, Baltimore

If you use the Patriot’s inflated claim to the larger region, Springfield and and Worcester come in at #1, and #14 respectively  for best heart surgery hospitals, while Seattle has a hospital ranking #13, in the list:

Top 15 hospitals in U.S. for heart surgery (Source: Castlight Health)

  1. Baystate Medical Center, Springfield, Mass.
  2. Borgess Medical Center, Kalamazoo, Mich.
  3. Cleveland Clinic, Cleveland
  4. The Heart Hospital Baylor Plano, Plano, Texas
  5. Kaiser Permanente Sunnyside Medical Center, Clackamas, Ore.
  6. Kaleida Health (Gates Vascular Institute at Buffalo General Medical Center), Buffalo, N.Y.
  7. Mother Frances Hospital-Tyler, Tyler, Texas
  8. St. Joseph Mercy Hospital, Ypsilanti, Mich.
  9. St. Joseph's Hospital Health Center, Syracuse, N.Y.
  10. St. Vincent Heart Center of Indiana, Indianapolis
  11. Sequoia Hospital, Redwood City, Calif.
  12. Spectrum Health - Grand Rapids (Meijer Heart Center), Grand Rapids, Mich.
  13. Swedish Medical Center-Cherry Hill Campus, Seattle
  14. UMass Memorial Medical Center, Worcester, Mass.
  15. Valley Hospital, Ridgewood, N.J.

Using an access benchmark, Boston ranks #5 while Seattle doesn’t make this list:

Top 10 Cities With The Highest Per-Capita Ratio Of Both Hospitals And Primary Care Physicians Per Resident (source: Vitals)

  1. Cleveland
  2. Minneapolis
  3. Milwaukee
  4. Kansas City
  5. Boston
  6. Omaha
  7. Denver (tie)
  8. Miami (tie)
  9. Atlanta
  10. Nashville

And finally, perhaps in a bit of a stretch, Seattle placing an Executive in the this Most Influential list, while Boston is ignored:

Modern Healthcare: 10 Most Influential Physician Executives And Leaders (source: Modern Healthcare)

  1. Richard Gilfillan- President and CEO, CHE Trinity Health, Livonia, Michigan
  2. John Noseworthy- President and CEO, Mayo Clinic, Rochester, Minnesota
  3. Gary Kaplan- Chairman and CEO, Virginia Mason Health System, Seattle, Washington
  4. Margaret Hamburg- Commissioner, Food and Drug Administration, Washington
  5. Ardis Dee Hoven- President, American Medical Association, Chicago, Illinois
  6. Patrick Conway- Deputy Administrator for Innovation and Quality, CMO, CMS, Baltimore, Maryland
  7. John Kitzhaber- Governor of Oregon
  8. Glen Steele Jr.- President and CEO, Geisinger Health System, Danville, Pennsylvania
  9. Jonathan Perlin- President, Clinical Services CMO, HCA, Nashville Chairman-elect, American Hospital Association, Nashville, Tennessee
  10. Toby Cosgrove- CEO, Cleveland Clinic, Cleveland, Ohio

Population Health Management - Integration of Medical and Pharmacy Benefits 

By Claire Thayer, January 22, 2015

A new Blue Cross Blue Shield Association (BCBSA) and Prime Therapeutics LLC (Prime) study examined yearly medical costs of 1.8 million members of Blue Cross® and Blue Shield® (BCBS) independent companies, whose pharmacy benefit services were divided between “carve-in” and “carve-out” benefit options.  This study finds that members integrating the pharmacy benefits experienced:

  • 9% fewer hospitalizations
  • 4% fewer emergency room visits
  • 11% lower medical costs

HealthPartners, in their Pharmacy Integration Study, estimated that integrating medical and pharmacy benefits can save a group with 9,000 continuously enrolled members more than $1 million per year.  These and other data points are featured in MCOL’s infoGraphoid this week:

MCOL’s weekly infoGraphoid is a benefit for MCOL Basic members and released each Wednesday as part of the MCOL Daily Factoid e-newsletter distribution service – find out more here.


Making the Old New Again

By Kim Bellard, January 22, 2015

I always love it when someone looks at something familiar in a completely new way.  I only wish health care had more examples of that.

The example of this kind of totally fresh thinking that caught my eye concerns traffic lights.  If researchers from Carnegie Mellon University, led by Professor Ozan Tonguz, have their way, those familiar yellow boxes with the lights could become unnecessary.

The CMU researchers have developed "virtual traffic lights" (not to be confused with the separate CMU "smart traffic signals" project).  Instead of using physical traffic lights, lights would show up on the driver's dashboard as needed.  As Professor Tonguz told CNN: "With this technology, traffic lights will be created on demand when [two cars] are trying to cross this intersection, and they will be turned down as soon as we don't need it,"

The researchers claim the virtual, on-demand signal could reduce commuting times by 40%, as well as reduce carbon emissions and accidents.  And, of course, we wouldn't need all those physical lights; think of the savings on new lights, poles, and wires, plus on ongoing maintenance.

All that would be required is that every car -- and that means, every car -- is equipped with the required vehicle-to-vehicle communications technology.  No small task!  Some think this could happen in a year or two, others a decade or two.  Either way, it's mind-blowing to think that such a familiar part of our driving experience could be so utterly transformed by what seems, in retrospect, such an obvious solution.

Let's contrast this kind of thinking with health care.  Yes, I know -- health care has plenty of new technology and many kinds of improved treatments, but I'm not sure we're getting a lot of reinventing.  Where are our virtual traffic lights?

One small -- well, maybe not so small at that -- health care example is a new patient tracking system called PatientStormTracker, developed by Lyntek Medical.  As the name suggests, PatientStormTracker borrows from weather tracking to present patient monitoring data as systemic color monitoring.  Instead of trying to follow the usual rows and rows of data, clinicians can actually see a patient's status -- color-coded -- and watch it progress in real time, including which body systems are currently being impacted and how much.  

Lyntek's founder and CEO, Dr. Laurence Lynn, told The Columbus Dispatch that traditional patient monitoring is like a fire alarm -- either on or off.  As he said: "We have this simple fire alarm idea that existed from the 1980s, and it didn’t evolve, it didn’t improve."  Dr. Lynn wants to monitor patterns and detect trends earlier, when interventions are more likely to be effective.  PatientStormTracker is in clinical trials.  

One proponent of radical changes in health care has long been Dr. Eric Topol, who happens to have a new book out (The Patient Will See You Now: The Future of Medicine Is In Your Hands).  I have not yet read his book, but I did read his related op-ed in The Wall Street Journal.  His version of virtual traffic lights, if you will, is the smartphone.

Dr. Topol outlines not just increasingly common functions like virtual visits or monitoring using a smartphone, but also apps that assist with testing and even diagnosis.  I especially like his prediction that wearable sensors will make it possible that "...except for ICUs, operating rooms and emergency rooms, hospitals of the future are likely to be roomless data surveillance centers for remote patient monitoring."  That would certainly upend how we view hospitals...finally.

Perhaps those remote patient monitors will use something like PatientStormTracker.

The smartphone technology options are cool, but what Dr. Topol sees as an even more important trend in putting all the newly-captured data in the cloud, mining it, and using it to target interventions.

Changes are going to come at us from seemingly left field.  We can never be quite sure where they will lead. It just takes some innovator to see the familiar in a different way -- and then manage to convince us, and the medical-industrial complex, to change.  


What exactly is Qliance?

By Clive Riddle, January 16, 2015

Qliance, recently discussed in Time Magazine as they are quick to tell you, just issued a news release  that their New Primary Care Model Delivers 20 Percent Lower Overall Healthcare Costs, Increases Patient Satisfaction and Delivers Better Care.

Qliance conducted a study "of insurance claims data from 2013 and 2014 for approximately 4,000 Qliance patients covered by employer benefit plans, and compared the cost of their care to that of non-Qliance patients who worked for the same employers. The results revealed a savings of $679,000 per 1,000 Qliance patients on total claims –19.6 percent less than the total claims for non-Qliance patients during the same period."

Here’s data from a table they provided:


Incidents Per 1,000 Qliance patients

Incidents Per 1,000 Non-Qliance patients

ER Visits



Inpatient (days)



Specialist Visits



Advanced Radiology



Primary Care Visits



Impressive enough data, albeit its hard to know how much is apples to apples in the comparison. But the bigger question from examining this, is what is Qliance, what the heck is a Direct Primary Care model, and how is it different from other, more familiar models?

The first question is how exactly does one pronounce Qliance? The website FAQs didn’t have an answer for that question – like “clients” one would assume.

The next question would be, is Qliance a form of health coverage? The answer would be yes and no. Yes – you can contract to receive their medical services for a fee, but no – they are not an insurance plan.  One might think so when first arriving at their website – the navigation menu  refers to Members, Clients, Locations, etc, so one might assume Qliance is an integrated health plan.

But it is not.  As their FAQs will inform you, they are NOT insurance.  Instead they charge a monthly fee to provide primary care, with no fee for service charges.  Here’s what they say:  “We work directly for our patients to provide direct primary care. Your monthly care fee pays for our primary and preventive care services. Qliance does not bill any insurance carrier for our services, and Qliance monthly care fees are not reimbursable by any health insurance company, and may not be applied to any insurance plan deductible. Your insurance plan may be billed by others for services such as emergency, hospital, specialty care, laboratory tests, diagnostic imaging, prescription drugs or other goods and services that are ordered by your Qliance health care provider but are not performed or provided in our offices.”

So with or without health insurance, you can pay Qliance a monthly fee, and receive all the coordinated direct primary care services you want. But you or your health insurance, and not Qliance, will pay for any healthcare services Qliance does not provide. And depending on the type of managed care plan you have. your health insurance won’t pay for outside services ordered or prescribed by your Qliance doctor.

Sounds like a major stumbling block. Except that Qliance also works with self-insured employers to integrate with their health benefits.  Again, quoting from Qliance FAQs:  “We can work with any type of insurance plan. Most employers that incorporate Qliance into their benefits plans save 10% or more, with some employers saving over 40%”

Reading up on all the bells and whistles of Qliance – they seem to be a hybrid of a patient-centered medical home, concierge care, retail/urgent care clinic, with some purchaser-like capabilities. So the question is, in an age where integrated care holds much potential promise – why not keep moving bit by bit down the spectrum towards the purchaser end of the bar?

Perhaps first Qliance will just need to keep moving – to some additional locations. Right now you’ll just find them in the Seattle – Tacoma metro area of Washington.


Your Healthcare Lexicon for 2015 from A to Z

by Clive Riddle, January 9, 2015

Accountable Care Arrangements in Medicare, Commercial and Medicaid flavors

Big Data in healthcare parsed with Analytics

Collaboration between providers and purchasers

Deductibles loom large with continually increased consumer cost sharing

Engagement by purchasers with consumers and with providers

Federally Facilitated Marketplaces may or may not be able to provide future subsidies (see “K” & “S”)

Generic Drug prices are on the rise

Health Insurance Exchanges (Marketplaces) both public and private

Innovation Officers abound in health systems trying to transform how they do business

June is when we should find out what SCOTUS has to say about the next item (see “K”)

King vs. Burwell looms large on the Supreme Court docket

Long Term Care continues to be largely ignored while boomers age away

mHealth technology advances on all fronts

Narrow Networks are being deployed in Exchanges and elsewhere

Obamacare somehow remains the politically charged umbrella term for all things Affordable Care Act

Population Health Management has been embraced in the mainstream of plans and health systems

Quality Measures are being transformed with advances in analytics and reporting capabilities

Republican control of Congress ensures continued chipping away at the Affordable Care Act

Subsidies for public exchange enrollment are threatened (see “F”, “K” and “R”)

Tax Filings now require healthcare coverage information,

Uninsured are the topic of conversations of health plan marketing departments and political pundits

Value Based Purchasing is being sought by almost every purchaser

Wellness Programs for employers are being significantly scrutinized for effectiveness

X-Prizes in healthcare are on the rise with Innovation initiatives (see “I”)

Young Invincibles reluctant to signup for healthcare coverage (see “U”)

Zebras – may be easier to find in healthcare with advances in Big Data and analytics (see “B”)